Cold Heart, Warm Hands Holby City

Arthur said I'd never make it as a doctor.

Why should Arthur's opinion account for anything?

You want me to say you're better than Zosia?

She can be off her game, because she can play the dead mum card.

My mum had this thing about the pond in the field behind our house.

She told me never to go near it.

We had a huge pond behind our house.

My mum always said I wasn't allowed to go anywhere near it.

IVF. Of course. The nausea, the needle phobia.

Is this your third round?

When are you going to come and see Emma?

I've been seeing her with the nanny, when you're here.

I'm not going to let you poison me. Or Emma.

I'm taking her away from you.

Ooh!

Tell me it's the hormone injections that are making you want to kill!

Not the sight of my face!

-But I love your face, hun!

-Thank you.

I want to see your face in the face of my babies!

-Yeah, I know!

-So...

Let's...get...pregnant!

SHE LAUGHS

Come on.

It's like a tragic ballet on ice.

Cut the atmosphere with a knife.

Carve it into blocks. Make us an igloo!

You don't think Jonny will really launch

-a legal battle for Emma, do you?

-I'm way past knowing

what grief these two are going to dish up to each other.

Do I say something? Involve HR?

HR? What, Sophia from HR? She sticks her nose into Jac's business,

she'll be hanging from a hook in the morgue.

Morning, campers! How ya diddlin'?

Just when you thought it was safe to go back in the water.

-Alan Herring!

-Herring by name! Herring by nature!

-What's that even mean?

-No idea, Mo. It all just tumbles out of me

north and south. Half of it don't make sense.

-Lovely to see you, Alan.

-And you, Mo.

-But why are you here?

Wallpaper samples, Mo. I loved the Darwin decor so much last time,

I decided to recreate some of the ambience at home.

-That's not what it says here.

-Ah, Mr Hope!

Still getting extras work on the Hobbit movies, eh?

I thought I told you, we didn't want to see you back here again.

Shouldn't have done a cowboy job on me ticker, then,

should you, Pro-fess-or?

-SOFT LAUGHTER

-It says here he collapsed.

Ah! There they are - the Darwin lovebirds!

Last time I saw yous...

Ooh! ..waft of pheromones made me eyes water.

-Alan, how are you?

-Hi, how are you doing?

Jac Sprat, keeper of my heart.

By the way, I want it back some time.

HE LAUGHS

-What've you done now?

-I think you must've left one of your earrings

in here last knockings, cos something's not right.

High temperature, fatigue, night sweats, and chest pain.

Yeah. No biggie.

Only hurts when I breathe(!)

-We did an aortic valve replacement?

-Ten months ago.

So, Spratters... Word is, Jock slipped you his little scotch egg

and you two was off to play "happy families".

-Right, Alan, let's see if we can find you a bed, shall we?

-Uh-oh!

I know that look. Someone's not getting no sugar on his porridge.

-We're late!

-Sacha looks grumpy. Golden boy was early.

-No. We're late. Today, no mistakes. Agreed?

-I've got your back.

Afternoon.

We have a rush on hernias.

Er, Zosia, umbilical hernia in bed five, please.

Right, we have a hiatus hernia pre-op

and an inguinal hernia post-op.

Mr Carling - ready to go. Mr Cart's already been.

-Well, do we get to scrub in on the hiatus?

-Yes, you do.

-Yep, I'll take that.

-OK.

Ah, you caught the easy one. All done and dusted.

-Discharge. Think you can handle it?

-ALARM BUZZES

BUZZING CONTINUES

Seems like Mr Cart needs our help, again.

Bit of a buzzer-bug, I fear. Third time. Bed one.

-Did you know about this?

-No!

You better not have saddled me with a trouble-maker, Spreckles.

BUZZING CONTINUES

Don't wear your thumb out!

GRUNTING

-Oh, I'm going to be sick.

-It happens.

-HE RETCHES AND COUGHS

-That is why we stock

a lovely selection of paper bowler hats,

for your delectation...and vomit.

-Ooh.

-Sorry, I didn't mean to...

-That's fine. Like I said...

Kevin, it happens...

Kevin Cart?

As in Scurvy Giblet Wet-Fart Cart?

Serves you right, you fat little munter!

GASPING

Do I know you?

-Dr Tina's at 4:30.

-Do you think I'm going to forget that?

-Meet here or outside her office?

-Office.

And you, remember what she always says.

-Yes. So don't say it.

-Don't do a home pregnancy test.

You said it. Not at "home". So I can't.

-Hey!

-Search me, Officer.

-Look, no pregnancy test kits.

-Good!

-THEY LAUGH

-Don't be late.

-Mwah! I'm going to grab a coffee. Do you want...?

-Caffeine?

-You really think your sperm need caffeine.

-Come on!

I eat Brazil nuts, pumpkin seeds, broccoli, oysters.

-Just a big ol' lovin' machine!

-I've done selenium and vitamin B.

A little cappuccino's not going to hurt.

Yuck! Nothing in the world is worth chugging that for!

You promised - "whatever it takes".

-Well, I draw the line at wheatgrass snot.

-Mean it. Don't be late.

Nothing could possibly make me late.

Listen to Dr Tina. Wait for the official results!

SHE SIGHS

Ah, Raf. I was just about to page you. Glad I caught you.

-Where are we going?

-Freight handlers had an emergency call from the airport.

They just unloaded a cargo box under an hour ago.

It's a short flight from Rotterdam.

-All the way in the hold. Unpressurised.

-Sub-zero temperature.

-Practically frozen.

-What is?

-They found a body.

-A stowaway.

I want to see it. But I don't! But I do!

-HORN BLARES

-Wow!

HORN BLARES AGAIN

As far as anyone could see, the body was a dead body.

It was rigid, apparently.

Airport first aider thought she could feel a faint pulse.

Ambulance crew knew we had an ECMO machine at AAU, so...

-Looks like it's already news.

-Pulse described as very, very weak.

We found him like this in the hold, but we couldn't move him

because some metal's pierced his leg. I was sure I felt a pulse.

Show me.

Don't cover him. Keep him cold.

Excuse me.

You did good.

Darren Copeland?

-"Dar" Copeland?

-Dominic.

It's Dominic now. Deed poll. Dar?

I always hated "Dar". I mean, really, is that as inventive

as a schoolboy's imagination could possibly get?

Abbreviating Darren to "Dar"?

-You're a nurse now?

-Doctor, Wet-Fart! I'm a doctor!

You're a doctor? That's amazing!

-We all thought you'd go out...

-Poof-Dar! Gay-Dar! Bend-Dar!

-HE SNORTS

-You lot were so creative(!)

-You said you were going to be an actor!

-Well, I'm a doctor.

And I'm YOUR doctor.

And the big wheel of karma is turning round and round and round

and guess what?

You...Kevin... You're it!

-What's that mean?

-An inguinal hernia? Really?

You do realise that's THE most common type of hernia.

-One in every eight men.

-Mine was really painful.

-Ooh!

Body Mass Index of 40?!

Kevin, have you never heard of a treadmill?

Too many pastries. Not enough pilates.

-Mr Fart.

-Should I be seen by another doctor?

And what do you do for a living, Kevin?

-Warehouseman.

-Warehouseman? Oh, noble profession.

-There's a lot of heavy lifting. The hernia was caused...

-Kevin Cart MBE

for services to..."warehousing". I don't think so.

-I'm covered in sick.

-So you are. I'll have a nurse clear that up.

-All in good time.

-Do you know what...

Touch that buzzer once more...

-I stink of puke!

-Yes. You do.

-HE SIGHS

-You will stay there

and you will be quiet. But most importantly of all,

you will not tell anyone on this ward that you know me.

-I've got a really bad pain in my...

-And if you do, Kevin Cart,

I will tell my boss

exactly what you and your ugly ignorant friends did to me.

Did what to you?

It goes... # Boom-diddy-boom Diddy-boom-diddy-boom

# Diddy-boom-diddy-boom Diddy-boom-boom-boom... #

Shut up, Alan, or, so help me, I'll punch you!

There you go! Bit of the old Sprat back.

You love me really. Don't she?

Yeah, Nurse Maconie's the expert on human emotion.

Hang on, go back.

-Left again.

-Can you roll on to your right side, please?

-And they all rolled over and the little...

-Shut it!

Sorry, Alan, it's just we have to concentrate.

There.

-That look thickened to you?

-Maybe slightly.

What are you thinking? Infection or age-related wear and tear?

Oi! Enough with the "age" stuff!

-Let's wait until we see the bloods.

-Mmm.

You not discharged your inguinal?

Nope.

Right, well, I'm off to do a Nissen fundoplication repair.

Riveting(!)

-I think Sacha wanted that bed clear as soon as possible.

-That's the plan.

Pull the short hernia straw?

Yes and no.

I shouldn't tell you this...

-But...

-You want me to stop checking discharge meds forms

in order to look you in the face and say, "What shouldn't you tell me?"

Look, I can't. Patient confidentiality.

Dominic, we're not doing melodrama today. Sacha was gunning for...

You know I told you that I was bullied at school?

We need to get him out.

Do you want me to take over?

-No.

-We should intubate him. Get me a kit.

No. No intubation! I'm sorry.

The state he's in, oxygenation is the least of our problems.

We'll intubate him inside.

Do you think he's going to die?

Not if I can help it.

-Did we get that?

-Give me a job, Raf, please? Tell me what you need.

OK. Yes, good.

Look, er, we're going to move very quickly.

As his temperature rises, oxygenation will become crucial.

-Could lead to diffuse cerebral hypoxia?

-Precisely.

Now what I want is for you to go and get Ms Effanga.

Tell her to prep for cannulation, possible sternotomy.

-You want me to run an errand?

-Yes, that's it. Get Mo.

Well, go!

No. Stay with the boss guy. That one - he knows what he's doing.

Where's those cutters?

CUTTERS WHINE

LOUD GRINDING BAR SNAPS AND RATTLES

-You can't leave him like that!

-I know. I just had to tell someone.

-SHE SIGHS

-You're the only one I can trust.

I'll clean him and discharge him.

No, you shouldn't have to deal with it.

Look, Sacha told me to discharge him. So...

WE'LL discharge him.

Or we'll go and tell Sacha. There has to be some protocol about this.

No, it's fine, really. I'll clean him up.

Let's not make this official.

We discharge him together or I tell Sacha.

We know the vomiting isn't clinically significant

and there are no other problems.

No cock-ups. Noses clean. Remember?

OK. OK. Fine. We'll discharge him together.

But please don't tell Sacha.

I don't want to be the problem doctor today.

And I don't need everyone knowing my personal business. Only you.

You have no idea how happy I was to get your call.

"Come treat a frozen, lifeless body

"found in an air cargo container with practically no pulse."

-It's way more appealing than being on Darwin today.

-With Jac and Jonny?

Mm-hm. I hear urinary infections are more fun.

Thanks.

HEART MONITOR BEEPS

Er, the paramedics couldn't get any decent venous access.

His core temperature means his veins are in spasm.

-If you do get in, we pump Hartman's.

-Definitely. If we get in.

-Hartman's?

-It's a solution.

IV crystalloid solution?

-MO:

-What's his sats?

Er, no reading on the pulse oximeter. Suture.

-Heartbeat?

-Very deep. Very weak.

Right, so are we saying he's as good as dead before we even start?

His core temp is 22 degrees. You know as well as I do,

you're not dead until you're warm and dead. This guy's freezing.

So why are we not warming him up?

When everything's frozen, it's in shut down.

-Body tissue's in suspension.

-When it warms, the damage gets done.

Lack of blood, lack of oxygen - that's what'll kill him.

-What about bicarb? I read you should inject bicarb...

-Yeah, definitely(!)

That would kill him quicker than just about anything.

Overheat the blood before the heart can pump. End of story.

Look, you want to do something useful? Get rid of them!

Look, I'm going to need both of your help to get him on the pump.

-Sure.

-CHATTER OUTSIDE

Raf, we have to be very sure we're doing the right thing here.

What's the alternative?

That pump is here on probation.

We can't afford to make mistakes.

So, we helicopter him out to a specialist centre?

-Really?

-There is a news crew in the building.

Precisely! Look, this goes well, which it will, it's down to you.

You turning Holby into something dynamic.

Why do I get the feeling you're trying to butter me up?

Look, I'm just the monkey who works the machine.

You got us the machine in the first place.

If this is a baby, we're having it together.

OK.

177.

178!

179.

-SHE SIGHS

-I'm not looking.

Oh, my good God. I am looking!

Thank you! Thank you! Thank you! Yes! Yes! Yes! Yes! Yes!

Can I ask you something, Darren? As a doctor.

-You can shut your mouth.

-It hurts.

My chest.

My nipple really hurts.

Go and see your GP.

Or better still, don't.

-It's crazy. My nipple's so sore. I'm worried about it.

-Good.

-I'm embarrassed.

-You should be.

I don't think I remember school the same way you do, Dar... Dominic!

I'll never forget it.

-I don't know what it is...you think I'VE done.

-All of you.

-No, me!

-Me? What am I supposed to have done to...?

-Bullied me! Humiliated me!

-Hurt me!

-Bullied you?!

Dar, I'm Scurvy Giblet Wet-Fart Cart, remember?!

Man-boobs at 14! A ginger afro, freckles

and a mum that looked like a Princess Fergie blimp!

-Well, you ruined my adolescence.

-You think I wasn't get bullied?!

I mean, fair enough, you were a little poof...

What's going on?

Nothing.

It's about time we discharged you

and got you out of our hospital, Mr Cart.

-Are you a doctor?

-Yes.

-Could you have a look at my chest?

I told him to go and see his GP.

We were supposed to be discharging him, remember?

-What seems to be the matter with your chest?

-His nipple hurts.

My nipple's flipping leaking blood!

-Please leave the building.

-Dr Tressler, is it?

These ECMO machines, there are only - what -

five or six of them in the country? This is a fantastic...

-Listen!

-..news story.

-It is not acceptable for you to be here.

-It's not appropriate, I'm sorry.

-But...

-You look happy.

-You don't! Can I see him?

-He's in theatre.

I'll only be a minute.

-You look, erm...

-What?

-Flushed.

-Thanks(!)

-No, no. In a good way.

Good news?

What's he doing?

He's putting a patient on ECMO.

Frozen refugee found in the hold of a plane.

-Not a good moment, then.

-To see you?

Surely there's no such thing?

Smooth, Harry Tressler. Very smooth.

You like that? The way I flipped it over, turned it into a compliment?

Kind of weird.

Me? Weird?

You're saying you didn't see me

with a pregnancy test stick in my hand just now?

-I did.

-And this grin?

Well, you're either pregnant or you're not.

And thrilled one way or the other. Had to bet...

I'd go with pregnant.

A positive pregnancy test and still you're flirting with me?

There would be something wrong with me if I wasn't

and I know how much our dinner date meant to you.

Dinner date?

We went to a drugs launch buffet, because my husband couldn't.

Tom-ate-oes, tomatoes.

Incorrigible!

-What?

-Look it up!

-We don't need to tell Sacha.

-We absolutely do!

He has an oozing nipple and painful lumps in his underarm.

Sacha told me to discharge him. I'm just doing what I was told.

He might have a tumour, Dom!

I just... I don't want him here! The sight of him reminds me...

-You don't have to have anything to do with him...

-What if he says something?

-You really want to let him have power over you again, do you?

-Who?

Dom's inguinal hernia.

-Mr Cart?

-I thought he was just a simple discharge?

Well, actually, he's got a discharge.

-What, operation wound?

-Oozing nipple and lumps.

Let's go and take a look.

-I don't need everyone crashing in on my case!

-There is another issue.

-No!

-Apparently...

-Don't!

-Apparently...

-Don't!

Right, Arthur, go and examine Mr Cart, please.

Thank you.

I have warned you both!

Zero tolerance for medical student dramas, right?

Now, you - every ward patient file updated and ready for my rounds.

You - my office. File all past-patient cases.

And both, back in an hour to explain yourselves.

You were asked to stay in or around your bed, Alan.

Pump head syndrome.

-What?

-Google it.

-Why?

-I Googled it.

-Good for you.

-I Bing'd it. Yahoo'd it. The lot.

-So...

-I think I've got it.

-Post perfusion syndrome?

-Yeah. Ask the Prof.

Oi! Prof!

Could I have pump head syndrome?

Well, it's not actually a proper recognised...

They say Bill Clinton's got it.

That's why he's done some really stupid things.

-What does he think he's got?

-Post perfusion syndrome.

Like Monica Lewinsky.

I think I got it from here.

I do.

Thanks for letting me stay. I'll keep out the way.

Without you, he wouldn't be alive. We wouldn't be about to do this.

Good to go, guys. Chop-chop.

I'd love you to get as hands-on as you want here.

The more you know about ECMO, the more you'll love it.

-The more you'll fight for it.

-OK. Tell me what you want.

Opening the right femoral artery.

We injected 5ml of lidocaine around the site.

-Only local anaesthetic?

-What if the pain wakes him up?

In his state, waking up in any way, shape or form

is a good thing for him.

Yeah, if he's able to feel pain, then things are looking up.

Need the cannula, please.

We open and cannulate one vein and one artery.

Guy, you do the vein.

Suck the blood out of the vein using the pump,

through the extractor and back up the artery.

Raf?

Inserting the large bore cannula into the outflow.

Vein is cannulated.

-Clamps on and connected?

-On.

-Mm-hm.

MACHINE WHIRS

OK...

Slowly draining.

What flow rate would you expect?

Blood this cold. You know, start slow. Two litres.

Honestly, this...blows my mind.

The exchanger takes the carbon dioxide out of the blood

-and puts oxygen in.

-Warms it up too.

Clamps off?

-Off.

-Off.

BEEPING

Once it's warmed and oxygenated...

That's the good stuff. That's what'll bring him back.

Good job.

There is a study in America - only one, mind you -

that posits that people who have been put on a bypass machine

during heart surgery suffer cognitive impairment.

I was on one when I had my valves done. Turned stupid as a turnip.

As a result of being put on a bypass pump.

Pump head, see? Makes you do stupid things.

You don't need a bypass to make you do stupid things, Alan.

-No. But maybe it made me do extra stupid things.

-Like?

Frankly, I've always thought the whole idea was ridiculous.

-I entirely disagree.

-Why does that not surprise me?

-I'm sorry!

-The study at Duke University Medical Centre

suggests that during bypass, while on a pump,

the brain is showered with tiny fragments and bubbles of oxygen...

-Microemboli.

-My, you have been Googling.

..which can cause minor brain damage

and possibly some cognitive impairment.

Including "poor recall, social difficulties

"and personality changes".

We have done a thousand bypass procedures.

They're the meat and potatoes of our trade.

That doesn't mean they can't cause damage.

Really, you're going to go with this one small...?

As theories go, it carries some weight.

-In horse dung.

-Oh, and you'd know because?

-Because, up until today,

I'd never heard of it, because Professor Hope...

No, because if I think it's true, then it must be wrong?

Oh, yeah, Jac. That's right. Because anything you believe in

is bound to turn out to be some kind of poisonous cack!

I'm with you, Spratters.

Heart op pump made me soft in the noodle.

It's official.

Mr Cart? I've been looking for you. Er, where are you going?

Out of here. To another hospital.

-Why?

-Because I'm not staying here...with him.

LIFT BEEPS 'Doors closing.'

CROCKERY RATTLES HE CRIES IN PAIN

Wheelchair, please.

HE WINCES AND GROANS Stay still, stay still.

Try not to move.

KNOCK ON DOOR

-I know that grin. You did a test.

-No!

-You lie.

-I do.

-What?

-What do I always say?

-"Don't do a home test."

-What did you do?

-A home test.

You're mad! What did I say?

-I said it too!

-And by the looks on your face, it read positive.

-Yes.

-Is she?

-Are you?

-Why do I always say not to do tests?

Not to get your hopes up.

Not to drive yourself and your partner crazy with unreliable data.

Not always unreliable.

-No. But a home test...

-Isn't as accurate! I know.

-So...?

-Home tests can give false positives,

-because you have HCG in your blood.

-I know!

I injected it myself. Remember?

Makes your body think it's pregnant.

Just for a while. Then...

-Is she?

-My breasts tingle.

I feel like I'm about to start my period the whole time.

It would explain the violent mood swings.

And I've got that weird metallic taste in my mouth.

-Is she pregnant?

-I am pregnant! I know it. I can feel it.

No.

No?!

No, you are not pregnant.

-You're joking.

-Sweetheart, I wish I was.

OK...

You've popped some sutures.

What's this?

-OK, is that hurting?

-Ow! Yeah, yeah! Ow, ow, ow!

-Yeah.

-Oh!

OK. I'll redo your sutures, and then we'll find out what this is.

Just...

Just don't let him touch me.

Who, Mr Cart? Who mustn't touch you?

-Hi.

-Why did you want to see me here?

I just thought we could take some time away from work,

from the ward, to discuss what's...

What's going on?

-Professor Hope's personal mediation service.

-Please.

I don't want to run a professional department

with a personal turmoil raging at its core.

Who's raging? I'm not raging?

-I'm as calm as a mill pond.

-Yeah, right(!)

-I have been made aware, through Ms Effanga...

-Huh?!

-Why does that not surprise me?

-Motormouth Mo.

..that you intend to challenge Jac for custody of Emma.

No disrespect, but, um...

this really isn't within your remit.

Within my department.

Between...my friends

Look, I appreciate that, in the shock and aftermath of Bonnie's death,

-you might not exactly be thinking straight and so...

-Don't...

And so, in understanding of this...

I'm prepared to absolutely forget what you said to me...

-Don't you dare!

-..when you threatened to challenge me.

Don't you DARE use Bonnie's death as an excuse for MY behaviour!

I am fighting you...

because I believe that you will do my daughter harm.

-I tried. One-time offer.

-And for your information....

..I have a lawyer already instructed and quite ready to prove

that you're not fit to have sole custody of Emma.

What's going on?

Hmm? You said yourself, you caught an easy one.

You know, hernia discharge. You can't do that without a fight?

-We weren't fighting.

-Well, that's not what it looked like.

It's personal. I didn't want to have to say.

He has a history with the patient.

A history?

-We went to school together.

-Well, that's fine. It's no big deal.

Arthur and Zosia can take over, OK. Just keep out of his way. OK?

SHE SIGHS

-Am I missing something?

-Tell him!

-No!

Tell me what?

He...bullied me.

-At school or...?

-Zosia wanted me to come and report it to you.

I didn't want to say anything. I just wanted to get on with my job.

Unfit mother, Elliot. You heard him.

I don't mean to sound petty but he started it.

Jac, if you get legal representation, it gets official.

Messy. Impersonal. Bureaucratic.

He's questioning my ability to be a mother!

Of your daughter. Your baby. A tiny little package of life

-which you both went through so much to bring into this world.

-Yes!

-MY daughter! She came from MY body.

-A child that you're both

going to stand in front of a judge and squabble over?

-Unfit mother.

-I know.

-Do you have any idea what it feels like...?

-Please, please!

Just let me talk to him.

Before you to go war, let me try and make him back down.

Ah, lovely-jubbly! Just the guys I was looking for.

The Yin and Yang of the "pump head" debate.

You know the sort of clients I hate treating most.

Ones who've got nothing wrong. You told us.

Clients who've got no physical reason not to get pregnant

are worst, because I've got no answers.

Got an answer for me?

-For us?

-Other sort of clients I hate

are anyone in the medical profession.

Doctors are worse because they don't believe you.

They think another doctor will give them another answer,

because they know doctors.

-Not infallible.

-Are you saying we should get another opinion?

Sure. Go private. Go abroad. Do whatever gives you hope.

-Because?

-Because I'm not going to give you much.

-Come on!

We've only had three sessions of IVF. Some people have ten.

-It's not a question of money.

-I know.

You can throw money at IVF and get results sometimes.

But only if you've got a sound basis to work on.

-We haven't?

-I just feel, in your case,

there are issues in compatibility that we need to address.

This last set of IVF, as you know,

we did ICS - intracytoplasmic sperm injection.

One sperm directly injected into one egg. Best bet all round.

-But Amy didn't get pregnant?

-No.

-Doesn't mean we have to stop.

Long ago, I learned never to say never in this job.

It's the same in my world.

The human body is an amazing and a surprising thing.

We just have to keep trying.

Oi! You look at me, you think "Lager Man". Am I right?

Dyed in the wool amber nectar necker.

-A liking for a particular...

-Rose!

Rose vino! Wine! I'm buying it by the box!

-Again...

-Strictly Ballroom! Sudoku! Steaming showers!

-I mean, I'm a bath man!

-None of these minor developments

change my mind about pump head syndrome.

-Excuse me, I have to go.

-Then there's the affair.

24 years a loyal, faithful, loving husband. Suddenly,..

..I'm bonking me book-keeper.

How do you explain that, Professor?

Hmm?

What was that in there?

-The S word. We don't mention the S word now?

-Please!

-I've got a patient about to go into...

-Sperm, Raf.

-Sperm. Sperm. Sperm. Sperm.

-HE SIGHS

Blood exchange is a long, slow process.

We have to keep constant monitoring. And fit a Bair Hugger.

I'm also keeping a close eye on heparin levels,

which controls the viscosity of the blood.

Don't get me wrong. ECMO. Resus. Very compelling medicine.

But it's kind of passive. Do you know what I mean? It's, um...

reactive, not pro-active.

-Oh...OK.

-Personally, I'm more of a sort of, er...

knife-and-fork, up-to-the-elbows kind of surgeon.

Is that blood?

Mr Self, there's a bleed!

Yeah, blood pouring out at the cannulation site.

OK, get Raf.

-Er, he's got a consultation.

-He needs to be here now. Go get him.

-Yeah, no...

-I said go!

Now give me a swab!

-One sperm was injected into one egg. One "Class A" egg.

-Ah!

-So it's my fault?

-No, Raf!

It's your sperm's fault. Over which I accept you have little control.

-Is this an appropriate place...?

-You know well as I do,

tests showed the mumps you got in Malaysia damaged your testicles.

-OK, so we might need more attempts...

-The mumps

and a possible gene abnormality mean your little guys are ruined.

It only takes one.

-You might not have one. A working one.

-OK!

-So it IS my fault.

-Don't do this, Raf.

I want to have our baby. Not watch you behave like one!

You're a doctor.

There are alternatives. Let's examine those alternatives.

Let's just be clear about this. If there's a problem with my sperm,

you are prepared to... KNOCK ON DOOR

-Excuse me. Sorry.

-I'm in a meeting!

-It's Bakaray, big bleed.

-Get out, Harry!

Guy's scared he'll bleed out.

I've got to go.

A mass? What's a mass? Is it bad?

Er, it just depends what kind of mass it is.

Well, what kinds are there? I mean, I tried to show it to Darren...

-Darren?

-..but he wouldn't even look at it.

Now you're telling me I need to do this needle...what?

Fine needle aspiration cytology. It's a further examination.

I'm not saying we were best mates or anything,

but, of the boys in our year, I'd say I was one of his few friends.

Right. It's a histological biopsy of the mass. Sorry, OK, who is Darren?

Dr Copeland. Dominic.

-What, OUR Dominic?

-I used to go round his house.

His mum used to bake these home-made Cornish pasties. Proper crinkle top.

-My mum couldn't bake a brick.

-OK, well, um...

Under the microscope, we'll be able...

I still see her down at the supermarket.

-She works Saturdays on the deli counter.

-Yeah.

..to identify the formation of cellular...

-His mum?!

-Yeah, well, not to talk to, exactly. But, you know, nod hello.

-You mean his stepmother?

-No, his mum.

No, he doesn't have a step mum. His parents are just his parents.

Right, erm...

Dominic's mother is, er...

-is dead.

-Oh, my God! When?!

I only saw her, like, two weeks ago!

She died when he was 12. Um, the dog drowned.

-The dog?

-Yeah.

Nah, he's Mr Allergic.

He used to carry, um, tissues up his sleeve, like a granny.

-That's one of the reasons he got stick.

-Right, OK, so Darren...

-..is Dominic Copeland?

-He told me not to say nothing.

-But then you found a mass!

-Right, OK.

The cytology's just a precaution.

Carole Copeland's dead.

My mum will be gutted.

The post perfusion study cites that cognitive decline

is more about the slowing down of mental reactions.

He don't look at you like he used to.

Inability to perform mental arithmetic sums.

-Are you having a barney?

-Some vocabulary diminishment.

-Or is it more serious?

-Not having an extramarital affair!

Who? You? Me? Or him?

You!

Personality changes. That's what it says.

I mean, I never used to fancy Sylvia. Now I do, see?

They refer more to depression, increased mood swings.

Could have something to do with it!

-I don't know, Alan. Maybe...

-Maybe works for me!

Tell that "maybe" to my lawyer.

Hi. It's very nice to meet you.

Suction. Come on.

-What happened?

-Haemorrhaging round the cannula.

We need some more units of cross match.

I'm trying to put an extra stitch in round the cannulation area.

If you can't put in a purse string, you'll have to pack it.

Trying to pull the string against the flow! I can't see a thing!

-Suction!

-What's the ACT?

-400.

-Why's that so high? It should be 180.

-I increased it. I gave him the usual dosage - 25K.

-Did I tell you to?

-No, but...

-Well, that's why the bleed's out of control.

Because the heparin's way too high.

-Do you mind if I...?

-No, please.

-Give me some tape. Just below the cannulation site.

-Way ahead of you.

-Could you just...?

-Put my finger on that artery?

-Do you want me to...?

-Get out of my theatre before you kill my patient?

Yes, please!

Can you give me some glue and some Fibrillar?

We'll pack the site and slowly release the snares.

What exactly is it you're doing?

Basic stuff.

Just a trick I picked up in Malaysia.

Their vascular guys make me look like a troll tying crab pots.

OK, pressure's coming back up.

Good work.

Listen, Raf, I'll, er... I'll leave you to it, OK?

RAF SIGHS

You should definitely look at this.

We need to do a fine needle aspiration on the lumps.

Why does it feel like you just made me the problem with Sacha?

I don't like Arthur sniffing around.

Blood's warming.

-Pressure's dropping.

-ALARM BEEPS

Don't do this.

-Right, he's beginning to fibrillate.

-Maybe that's a good thing.

-No, there could be a bleed in the pericardium.

-No, no, no.

-He's tamponading.

-Right, what are the options?

Saw his chest open. Drain the pericardium.

We saw his chest open in this state and he'll die.

-We've got to get to that leak.

-What's the alternative?

-He dies.

All we'd require, Ms Naylor, is for you to appear in court

and give a professional testimony on Mr Herring's behalf.

You really need to go to all this trouble for a divorce hearing?

Well, it's not exactly a divorce.

I'm sorry, Ms Naylor, I'm not a family lawyer.

-I'm a criminal lawyer.

-Have you had a look at these?

-Criminal?

-Yeah. You see, Spratts...

I embezzled three quarters of a million from the VAT man.

-Staphylococcal endocarditis.

-Totally out of character.

-Not me at all.

-Embezzlement?

-Exactly!

I mean, does that sound like me?

-Endocarditis?

-Vegetations.

It wasn't a thickening of the valve walls.

It's vegetations, bacterial formations around the valve.

Infection spread quickly. We're past antibiotics, I'm afraid.

-Vegetations?!

-Growths around the valve.

We're going to have to remove the valve and fit a new one.

-I'm going to need another operation?

-As soon as possible.

You going to open me up, again?

Open you up, pop you on bypass and cut the valve out.

Unless, of course, you object to going on bypass again.

-What?

-You could just let the vegetations bloom around your valve

-until it stops working.

-And?

And then, your heart would cease to beat.

ALARM BEEPS

Wait!

-Do we want to do this?

-It's your call.

He's been through so much already.

Yeah, but if it wasn't for you, he'd be long dead.

Pressure's dropping like a stone.

Now or never.

SAW WHINES

Salt and vinegar or cheese and onion?

I would've said cheese and onion.

Naturally, I can tell, snack-wise, you're no choccy comfort-eater.

That's a fat girl's game. But, erm...

Bad news?

I couldn't help noticing earlier, when, er...

-You barged into my office.

-The boss told me to go get Raf.

Yeah. But now, go away. Please!

Raf's got a nightmare on his hands. Another emergency.

Big surprise! My worst moment in living memory

and he's spending it with an ECMO pump!

Not pregnant, then?

-Not your business!

-I know, I know.

-So go away!

So what is it? Eggs or sperm?

You really didn't just ask me that!

Sperm, then.

You ever been punched in the throat by a Chinese girl, Harry?

No. I've been slapped in the face a few...

..times.

We should put some warm saline in the pericardium.

Pericardium is cauterised.

Excellent.

Right, all I need to do now is... Paddles, please.

..shock this patched-up heart back into some kind of normal rhythm.

-Charge to 20.

-Charging.

You know what, I do love your ECMO machine.

-It's a cracking bit of kit.

-I knew you would.

But it's got nothing on these things. Knives, saws, paddles.

Charged.

Shocking!

This, Raf, this is surgery!

Charge again!

So, like I explained, um, we'll sit you down.

There we go. Er...

So we'll locate the mass and then we'll insert

-a special hollow needle into it.

-Several times.

Yep, and then we'll remove some tissue samples

from the centre of the mass.

-Let's get that off. It'll be a little bit sore.

-Ah!

OK.

Er, yes, sometimes a few punctures of the needle is necessary. It's just

so the cytopathologists have enough tissue to run their tests.

-Is this going to hurt?

-Yes.

-OK, erm...

Maybe we could give Mr Cart a local anaesthetic, just to dull the pain?

If absolutely necessary.

-Don't want to suffer if I don't have to.

-Yeah.

Not a reasoning you applied to your own actions.

Zosia! Just want to say that, as a result of

a totally confidential conversation that I've had with our patient,

it occurs to me that we may have grasped, or more to the point,

been given the wrong end of the stick.

-I'm sorry, what?

-Some of what we think we may know

regarding the history between our patient and a certain F1 doctor...

(it may not be true.)

So if we...

And then I'll...

OK.

There we go.

Can we just have one question at a time, please? ..Yes?

Yes, Kim Keeble, HL1 TV.

Can you tell us exactly what is an ECMO machine?

I don't want to blind you with science,

but what Mr Di Lucca and the Acute Admissions Unit team

achieved here today is nothing short of a miracle.

These machines, ECMO pumps, are used in intensive care situations

to maintain pulmonary function.

To keep heart and lung patients alive.

But what we did here today

was to adapt this machine for use in a different context -

on an emergency patient.

Now, we strongly feel that these machines

should be available in every emergency department.

-You brought him back from the dead?

-That's probably an exaggeration.

They're calling what you do the "Lazarus Technique".

And what you did today was "nothing short of a miracle",

according to a leading specialist.

Er, well, let's not get too prosaic...

It was a miracle! It made me totally want to become a doctor!

Seriously, I was going to pack it in, but...seeing your team...

I'm going back to medical school. Taking my exams.

And judging from Lisa's performance today, she'd make a great doctor.

REPORTERS SHOUT QUESTIONS

-LAWYER:

-'This could work entirely in our favour.'

They're about to zip open me ribs and lop off the top of me ticker!

-On bypass!

-On or off, I could still snuff it before dinner time.

But if you survive, Mr Herring, another bout of bypass.

Another dose of pump head syndrome!

We've even more excuse for your financial misjudgement.

-What, where we blame the doctors for what I done?

-Er, now!

-I'm your lawyer. I know nothing of this.

-Oh, please.

I robbed the books, cos I was trying to show Sylvia I was Jack Flash!

Please, do not say such things in my presence. I have to defend you!

-They're ready for us now, Alan.

-This could be a landmark case.

You know what?

-I don't care.

-I'll collect evidence and testimony.

Are you absolutely sure you want to drag the people

about to try and save your heart through the courts?

Yeah, don't bother, Mannesh. I'm not going to lie and cheat.

Court or not...I could die in there.

So you're not going to fight the pump head angle?

What about Bill Clinton?

You know what, Jac, you're right.

What will be will be.

Sometimes, you've just got to take it on the chin.

Is he going to live?

-Yes.

-This morning, he was a lump of frozen meat. Now...

Not quite frozen. More like a ready meal.

-Chilled.

-What I mean is, you made him live again.

Raf...

you can work miracles.

Don't you start with the miracle stuff.

I want my miracle.

Our miracle.

-Do you think I don't?

-Not as much as I do.

Even that girl, the first aider.

You changed her life but you won't change mine.

-I've said I'll go on any drugs that you want me to.

-Why haven't you?

The side effects - water weight gain and painful man boobs.

-What if they don't work?

-Well, let's just try first.

I need to know what we do if they don't.

If ever we needed proof he's an inveterate liar,

next to poor old Kevin and his TB, Darren's mum.

-Don't walk away from me.

-This is not the time or the place.

-For me to hear you're committed?

-To you?

-You don't think I'm committed to...?

-Having a baby. Starting our family.

-Doing whatever it takes.

-And that means what?

-Sperm donor.

-Let's not do this here.

We can do it anywhere you like, Raf. So long as we do it now.

You would really carry another man's baby?

-My egg. Our baby.

-But not mine?

Don't pretend. Without my sperm, it's not mine.

We bring it up. It's our baby.

-No.

-And if you don't have a single fertile sperm,

-we don't have a baby?

-I'm not bringing up another man's child.

-My child! For God's sake!

-But not mine.

So, if YOU can't do it, WE don't do it?

What about me?

We have our work. We have each other.

-You could take another degree. Do your PhD.

-I want to have a baby!

-Yeah, and if we can't, then we...

-I've injected myself with hormones.

Run the nightmare of tests, scares, almosts and chemical pregnancies!

-I've done everything I can!

-But I can't do what's required of me?

You know, why not just print me a T-shirt - Firing Blanks?

No-one cares what we do, Raf!

Except us!

-It's no-one else's business!

-For me, another man's baby...

It's worse than no baby at all.

DOOR SLAMS

-What?

-Super Save's Employee of the Month!

For January!

-That chubby little snitch.

-Delicatessen counter.

Thought she drowned in a pond trying to save your dog Winston?

-You told us your mother died!

-For you. Because yours did die.

-Oh...

-I'm sorry?

You lied about your mother dying so I would like you more?

It makes me seem more interesting. Because the truth is...not at all!

How are we supposed to believe that anything you say is truth or fantasy

if you're going to lie about your own mother's death so elaborately?!

What about the bullying? Kevin Cart?

-I was bullied at school for being gay.

-Yes, but by Kevin?

-Yes!

-I definitely think so!

-SHE LAUGHS

Why do you need to be so devious? You are so slippery!

I believed all of this!

Never again!

DOOR SLAMS

Hey.

I've got a patient allergic to morphine. What do I give him?

How long have you been a doctor?!

OK, so maybe it was just an excuse.

-To poke your nose in?

-To see how you are.

Look, I know you probably hate being asked you if you're OK, but...

you look a bit ruffled and you did just have

-a very public ding-dong with your husband, so...

-No.

Really relish the attention.

-Yeah, thought so.

-Just bursting to tell everyone -

from complete strangers to sexually predatory doctors -

all my personal secrets.

Predatory?! Is that how you see me?

That's how the entire female population of this hospital see you.

In a bad way? Because I don't get a lot of knock-backs.

-At least I make you smile.

-Yeah.

Things back there looked pretty intense.

-You trying to cheer me up or depress me?

-Sorry.

According to your husband, I'm crap at my job,

-so maybe I can't do anything right.

-He on your case?

All. The. Time.

Frankly, it's hard competing with Mr Perfect.

He's not perfect, believe me.

Yeah? Well, erm...

..that's good to know, because...

-What?

-Oh, nothing.

-What?!

-It's just, sometimes,

he acts like he knows what's best for everybody and maybe he does...

He doesn't.

He's a very clever man.

He doesn't always know what's best.

-Trust me.

-Yeah?

So tell me.

Give me a minute.

Still experiencing conditions of permafrost?

-There has been some thaw.

-Oh, well, I'm not feeling it.

-Did you miss me?

-Like I'd miss herpes.

-Is that the gold-digging Sylvia in there?

-Er, No. Alan's wife Jill.

She obviously forgave him his stray from the path of righteousness.

Maybe she just thought he deserves a second chance.

Some women only have themselves to blame.

Not been easy, but I think I may have

-poured a little balm over troubled waters.

-Mmm.

This is Jac Naylor. You're going to need a tanker-load of balm.

-I'm off.

-Right.

-Look, Jac, I...

-Listen, I, er, meant to give this to you earlier on.

Vanessa Pryce - your typical rabid rottweiler in kitten heels,

-but if you want a job done properly.

-What?

My lawyer.

CARD CRUMPLES

He lied about his mother dying to make you like him more?

-It's almost flattering.

-That's completely insane behaviour!

I did it to make myself seem more interesting.

-You saw my mum.

-Yes.

What, you've never lied to make someone like you, Spreckles?

-Er, no. Never!

-Well, aren't you lucky?

I didn't think anyone would like me for being me.

"Gay Darren".

-Well, frankly...

-Look, I'm sorry. Please don't hate me.

-I won't lie to you again.

-I don't hate you.

You're fascinating.

I've never met anyone with such a fluid concept of the truth.

Albie's for a pint?

Come on, Arthur.

What?!